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Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk. [ABSTRACT FROM AUTHOR]

Introduction: The European guidelines recommend using the Systematic COronary Risk Evaluation (SCORE) charts to assess the absolute risk of fatal atherosclerotic disease in apparently healthy persons in order to guide risk factor treatment. It is not clear if the SCORE algorithm is useful for identifying the prevalence of subclinical atherosclerosis in an unselected population. In this first interim analysis of the large Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort, we explored the association between SCORE and prevalent calcification of the coronary arteries or prevalent plaques in the carotid arteries. Hypothesis: The SCORE estimated risk is associated with prevalent subclinical atherosclerosis in people without established cardiovascular disease or diabetes mellitus. Methods: We randomly invited individuals aged 50-64 years from the general population of six Swedish university cities. The study population included between November 2013 and December 2016 consisted of 13,397 participants, age 57 (SD 4.3) years; 46% males, after exclusion of subjects with; prevalent cardiovascular disease or diabetes mellitus; and missing data (n=2,318 and 589, respectively). In addition to the determination of the traditional cardiovascular risk factors, we recorded data from a computed tomography scan of the heart and ultrasonography of the carotid arteries. We analyzed coronary artery calcium score as present or absent coronary calcification. Presence of plaques in any of the carotid arteries were recorded. The individual SCORE value was calculated and log transformed before analyses. Results: Coronary calcification was present in 41% and plaques in any of the carotid arteries in 56% of the participants in the study population. One unit higher SCORE was associated with an odds ratio (OR) of 2.75 (95% CI, 2.62 to 2.90) for having coronary calcification, and with an OR of 1.85 (95% CI, 1.77 to 1.94) for having ≥1 carotid plaque on any side. Conclusion: In conclusion, SCORE estimated risk was associated with prevalent subclinical atherosclerosis in two major vascular beds in a general population sample without established cardiovascular disease or diabetes mellitus. [ABSTRACT FROM AUTHOR]